腔镜甲状腺术不同CO_(2)气压对患、者脑氧饱和度及术后早期认知功能的影响  

Effects of different C02 insufflation pressure on cerebral oxygen saturation and early postoperative cognitive function in endoscopic thyroid surgery

作　　者：程鹏[1] 胡胜红[2] CHENG Peng;HU Sheng-hong(The People's Hospital of Taihu country,Taihu 246400,Anhui;不详)

机构地区：[1]太湖县人民医院麻醉科,安徽太湖246400 [2]安庆市立医院,安徽安庆246000

出　　处：《安徽医专学报》2021年第4期53-55,共3页Journal of Anhui Medical College

摘　　要：目的:探讨腔镜甲状腺手术中不同的CO_(2)气体压力对脑氧饱和度(rScO_(2))和术后患者早期认知功能(POCD)的影响。方法:择期行腔镜甲状腺手术的患者40例,ASAⅠ~Ⅱ,随机分为A组和B组,每组20例,其中A组和B组患者的CO2充气压力分别为4~6 mmHg和6~8 mmHg。采用简易精神状态检查表(MMSE)于术前1天和术后第1.7天对患者的认知功能进行评估;持续监测并记录麻醉诱导前(T_(1))、充入CO_(2)30 min后(T_(2))充入CO_(2)60 min后(Tg)和麻醉苏醒后(T_(4))的rScO_(2);抽取动脉血检测T_(1)、T_(2)、T_(3)和T_(4)时的pH值、PaO_(2)和PaCO_(2)抽取静脉血检测术前(Ta)、手术结束后即刻(Tb)和术后24h(Tc)时的血清NSE和S100β蛋白含量。结果:两组不同时间点的MMES评分差异无统计学意义,术后早期均未发生认知功能下降;手术期间两组患者rScO_(2)变化均不明显,与A组比较,工,和T,时B组患者的HR和MAP明显升高(P<0.05);与A组比较,T_(2),和T_(3)时B组患者的PaCO_(2)明显升高(P<0.05),但两组患者的pH值和PaO_(2)差异无统计学意义;两组患者不同时间点的血清NSE和S100β蛋白含量差异无统计学意义。结论:腔镜甲状腺手术中6~8 mmHg或4~6 mmHg的CO_(2)气体压力对脑氧饱和度和术后早期认知功能无明显影响,但4~6 mmHg的CO_(2)气体压力对血流动力学影响更小。Objective:To investigate the effects of different C0_(2)insufflation pressure on cerebral oxygen saturation(rScO_(2))and early postoperative cognitive function(POCD)in endoscopic thyroid surgery.Methods:Forty patients,ASA I or II,scheduled for endoscopic thyroid surgery were randomly divided into two groups(20 cases):group A and group B,the pressure of C0_(2)pneumoperitoneum were set at 4~6 mmHg and 6~8 mmHg in groups A and B respectively.Mini mental status examination(MMSE)was performed to assess the cognitive function 1 d before and 1 d,7 d after operation.The rScO_(2),HR and MAP were monitored and recorded at the time of preinduction(T_(t)),30min after filling C0_(2)(T_(2))or 60min after filling C0_(2)(T_(3))and post-anaesthesia resuscitation(T_(4)).The pH,Pa02 and PaC0_(2)were detected at the time of T_(1),T_(2)T_(3)and T_(4).The serum concentration of the NSE and SlOOp protein were detected at the time of pre-operation(Ta),immediately after surgery(Tb)and 24 h after operation(Tc).Results:The scores of the MMES showed no difference between the two groups at each time,and there was no patient with cognitive decline after operation.Compared with group A,HR and MAP were significantly increased at T_(2)or T_(3)in group B(P<0.05).The changes of rScO_(2)in the two groups were not obvious during operation.Compared with group A,PaC0_(2)at T_(2)and T_(3)were significantly increased in group B(P<0.05),but pH and Pa02 in both groups were not different.The serum concentration of NSE and S100 P protein were not different in two groups.Conclusion:Different pressure of C0_(2)pneumoperitoneum in endoscopic thyroid surgery has no significant effects on cerebral oxygen saturation and early postoperative cognitive function,but 4~6mmHg C0_(2)pressure pneumoperitoneum has less effects on hemodynamics.

关 键 词：腔镜甲状腺 人工气腹 大脑缺氧 认知功能 

分 类 号：R653[医药卫生—外科学]